Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asian and white patients

Cozma, Ioana; Atherley, C; James, N. J.

doi:10.1038/sj.eye.6701677

Cited by 50 publications

(51 citation statements)

References 3 publications

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“…Pearson et al [15] found that Asian, including Indians, Pakistani and Bangladeshi, living in the English Midlands had 4.4 times the incidence of keratoconus than their Caucasian counterparts. These findings were confirmed by two other studies conducted in the Midlands where the differences in incidence were reported as 7.5/11 [16] and 9.2/1 [17]. Hashemi et al [11] further reported that in Iran, non-Persian populations (Arabs, Turks and Kurds) had three times the prevalence than Persian ethnic populations.…”

Section: Epidemiology and Prevalencesupporting

confidence: 66%

Pediatric keratoconus: a review of the literature

2017

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Purpose To describe the epidemiology and prevalence, rates of progression, difference between adult and pediatric populations, and therapeutic approaches to pediatric keratoconus from documented literature. Methods A literature search was done on PubMed using key words including pediatric keratoconus, children with keratoconus, adult keratoconus, penetrating keratoplasty, corneal cross-linking and intra-corneal ring segments. The literature was reviewed and reported to explore the key epidemiological differences between the pediatric and adult population with regards to presentation and treatment options. Results Pediatric keratoconus is more aggressive than adult keratoconus, which has been explained by structural differences in the cornea between both populations. High rates of progression were documented in pediatric populations. While corneal collagen cross-linking, intracorneal ring segments and penetrating keratoplasties have been used as therapies in the pediatric population, the literature overwhelmingly shows higher rates of failure and progression despite these measures as compared to adults. Conclusion Pediatric keratoconus is more aggressive than adult keratoconus, and current therapies used in adults may not be sufficient for the pediatric population.

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Section: Epidemiology and Prevalencesupporting

confidence: 66%

Pediatric keratoconus: a review of the literature

2017

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“…Notably, Indians and Pakistanis consistently form the keratoconus majority ethnicity in Singapore [50][51][52][53] and the United Kingdom. [9][10][11] The ratio was statistically significant at 4.36 to 9.23 Indians/Pakistanis to 1 white. [9][10][11] The higher prevalence of Indian keratoconic patients outside of India [Singapore and United Kingdom (Tables 1 and 2)] strongly suggests genetic contributions over environment.…”

Section: Ethnicitymentioning

confidence: 88%

“…Asians in the United Kingdom were 4 to 5 years younger at diagnosis compared with whites. [9][10][11] Severity of Keratoconus Defining advanced keratoconus as 52 D or more on keratometry, the percentage of advanced cases in India ranged from 5% to 67.2%, which seems slightly higher than the 21% to 47% of advanced cases in Western studies (Tables 1 and 2).…”

Section: Mean Age At Diagnosismentioning

confidence: 90%

Review

Kok

Tan

Loon

2012

Cornea

103

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Keratoconus is an ectatic corneal disorder for which exciting therapeutic and diagnostic technologies are emerging. However, its pathogenesis is still heterogeneous and elusive. We researched overlooked Asian keratoconus data by literature review of databases (PubMed, MEDLINE, Ovid, Google Scholar, Cornea, and Cochrane) using key words "keratoconus, Asia, epidemiology, treatment, risk factors, genes" and names of Asian countries. Articles and their references were analyzed. Studies showed that keratoconus may be more prevalent, have earlier onset, and have greater disease progression in certain Asian and non-Asian ethnicities, particularly Indians, Pakistanis, Middle Easterners, and Polynesians, compared with white populations. Epidemiological risk factors include ethnicity, age (younger than 30 years), gender (male), positive family history, and eye rubbing. Genetic and disease risk factors include atopy, vernal keratoconjunctivitis, Down syndrome, pellucid marginal corneal degeneration, VSX1 (visual system homeobox 1) gene, and Leber congenital amaurosis. Differentiation of heterogeneous keratoconus subsets with detailed genotype-phenotype characterization may advance understanding. Comprehensive multiethnic population studies with valid large-scale data are needed. New effective treatments (deep anterior lamellar keratoplasty, intrastromal corneal ring segments, and corneal collagen cross-linking with riboflavin) are succeeding previous treatments.

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“…This observation may be a reporting bias, or as described in the literature, differences in prevalence may reflect diversity in genetic susceptibility. For example, Asians, particularly of Pakistani origin, have been shown to have a higher prevalence, incidence and disease severity than white patients in the UK,24 – 26 and in New Zealand, topographic indicators of early KC were more prevalent in Maori/Polynesian patients compared with those of European descent 27. Lastly, contact lens use was a predictor of family history, and it has been associated with more severe disease 9 19 27.…”

Section: Discussionmentioning

confidence: 99%